Supervised consumption sites explained
Supervised consumption sites (SCS) are part of a long-term, comprehensive approach to addressing the harms associated with problematic substance use.
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Reasons for supervised consumption sites
Problematic substance use has devastating impacts across Canada, on individuals, families and communities.
It is a complex issue. There is no simple solution.
SCS are part of our harm reduction approach to the Canadian drugs and substances strategy. This is because Canadian and international evidence shows clearly that they help to save lives and improve health. Research also shows that SCS are cost effective and do not increase drug use and crime in the surrounding area.
SCS are an entry point to treatment and social services for people who are ready to stop or reduce their use of substances. They do not provide their own drugs or substances.
People will use SCS for a number of reasons. They provide:
- a safe, clean place to consume illegal substances
- less risk of violence or confrontation with police
- drug checking to detect adulterants using methods such as fentanyl test strips
- emergency medical care in case of overdose, cardiac arrest or allergic reaction (anaphylaxis)
- basic health services, such as wound care
- testing for infectious diseases like HIV, Hepatitis C and Sexually Transmitted Infections (STIs)
- access to sterile drug use equipment and a place to safely dispose of it after use
- health professionals and support staff, including for overdose intervention
They also offer:
- education on
- harms of drug use
- safer consumption practices
- safer sex
- referrals or information on health and social services including
- drug treatment and rehabilitation (detoxification or drug substitution therapy)
- housing services
- primary health care
- mental health treatment
- community services
- social welfare programs
- needle exchange programs
Goals of supervised consumption sites
The key aims of SCS are to:
- prevent overdose deaths
- facilitate entry into drug treatment services
- reduce the risk of disease transmission (such as Hepatitis C and HIV) caused by unhygienic practices, such as needle sharing
- reduce public disorder from
- public consumption of illegal substances
- publicly discarded consumption equipment
- connect people who use drugs with basic health and social services
- reduce impact on Emergency Medical Services attending to drug overdoses
Health and social services include:
- drug treatment
- withdrawal management
- access to detoxification for people that are ready and willing to seek treatment
- housing services
How sites work
To be effective, SCS are set up in areas where there is public drug use. They are aimed at sub-populations of people who:
- use illegal drugs
- have limited contact with the health care system
These may include those who are homeless or living in insecure accommodation or shelters.
A SCS in an area with high rates of public consumption helps reduce public injecting and publicly discarded needles in the vicinity of the site.
They are often located near established illegal drug markets. This is how they can reach their target population.
However, there are different types. A SCS can be:
- integrated with existing health and social services, including other harm reduction interventions
- a specialized standalone service that focuses on supervised consumption
- a mobile service that caters to a smaller number of people who use drugs and who are spread across a wider distance
Often, SCS are set in areas where demand is greatest. However, they may be within an integrated site with other health, social and/or harm reduction services. In this case, the location may have been chosen based on availability of space or existing clinical or treatment services.
The hours of operation for SCS vary by:
- type of site
- site location
For example, a mobile site may operate at times when fixed sites are closed. This can fill any service gaps. Sites that serve a smaller number of clients may operate on a reduced schedule.
SCS staff varies by site, but generally include:
- nursing staff
- social workers
- peer and community workers
Depending on the site, SCS may permit use of substances by:
- inhalation (smoking)
- oral and intranasal (consuming pills and snorting)
The types of services provided are based on the needs of the population being served.
How sites are authorized
In Canada, possession of controlled substances is prohibited under the Controlled Drugs and Substances Act (CDSA). To operate a SCS for medical purposes in Canada, an exemption under section 56.1 of the Act is necessary.
Health Canada may grant exemptions for SCS after satisfactory completion of an application. An application includes consultation with a broad range of stakeholders in the community.
Each site is considered on a case-by-case basis, on its own merits. We take the information in the application and the public health and public safety objectives of the CDSA into account.
Exemptions for new SCS are generally granted for a year. However, the length of time for renewal applications can vary by site and past compliance history.
Apply to run a supervised consumption site explains how to apply for a SCS.
A list of approved sites plus the current status of SCS applications under review is available on our webpage: Supervised consumption sites: status of applications.
Overdose prevention sites
In December 2017, recognizing the need for rapid access to front-line services, Health Canada announced it would give temporary class exemptions to provinces/territories. These are for overdose prevention sites where evidence shows there is an urgent public health need.
Overdose prevention sites, also referred to as Urgent Public Health Need Sites, are temporary locations. They have traditionally been set up by volunteers. They are a space for people who use drugs to consume them and receive overdose response measures if necessary.
Site workers, peer workers and/or frontline staff monitor people after they consume. Staff is prepared to give naloxone or other life-saving responses as needed.
Both overdose prevention sites and SCS have a goal to reduce overdose deaths, but overdose prevention sites do not generally have the additional services or goals of a SCS. These include connecting people with other health and social services.
There are other differences. Overdose prevention sites have been set up temporarily to address the current opioid crisis. They operate with a limited structure.
For more information on overdose prevention sites, please speak to your local provincial/territorial health authority.
Interim supervised consumption sites
Interim sites are used to address an urgent need while approved permanent SCS sites undergo renovations. Applicants who apply for an interim site have already completed the full SCS review process. They have already received an exemption from Health Canada to operate a permanent SCS. For the most part we expect an interim site to close after the permanent site is opened to the public.
Our approach to drug policy
We are committed to a comprehensive, collaborative, compassionate and evidence-based approach to drug policy, using a public health lens to consider and address drug issues. For that reason, on December 12, 2016, the Minister of Health announced an updated drug strategy for Canada. This is called the Canadian Drugs and Substances Strategy (CDSS).
The CDSS formally brings back harm reduction as a key part of the strategy, among the existing pillars of:
- harm reduction
Restoring harm reduction allows us to better support measures to reduce negative impacts of drug use on:
- people who use drugs
- Canadian communities
Harm reduction-focused policies are now a formal part of our strategy. These policies include:
- increased access to naloxone
- support for properly established and maintained SCS
The CDSS replaces the National Anti-Drug Strategy.
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